oncology of colon cancer

1. COLON CANCER
Hamad Emad H. Dhuhayr

2. CONTENTS
• SOEPEL
• COLON CANCER

3. SOEPEL
• S A 60-year-old female patient was admitted to hospital for dyspnea, chest pain, fatigue
and recurrent plural effusion from 1 year.
• O taking history and physical examination.
• E chronic heart failure, renal failure and cirrhosis
• P Echo and ecg
• E medication.
• L colon cancer

4. COLORECTAL CANCER

5. DEFINITION
• Third most common type of cancer and second most
frequent cause of cancer-related death
• A disease in which normal cells in the lining of the colon
or rectum begin to change, grow without control, and no
longer die
• Usually begins as a noncancerous polyp that can, over
time, become a cancerous tumor

6. TYPICAL SITES OF INCIDENCE AND SYMPOMS
OF COLON CANCER

7. RISK FACTOR
• Polyps (a noncancerous or precancerous growth associated with
aging)
• Age
• Inflammatory bowel disease (IBD)
• Diet high in saturated fats, such as red meat
• Personal or family history of cancer
• Obesity
• Smoking
• alcohol

8. Development of CRC
Result of interplay between environmental and
Genetic factors
Central environmental factors:
Diet and lifestyle
35% of all cancers are attributable to diet
50%-75% of crc in the us may be preventable
Through dietary modifications

9. Dietary factors implicated in
colorectal carcinogenesis
consumption of red meat
animal and saturated fat
refined carbohydrates
alcohol
increased risk

10. Dietary factors implicated in
colorectal carcinogenesis
dietary fiber
vegetables
fruits
antioxidant vitamins
calcium
folate (B Vitamin)
decreased risk

11. HEREDITARY COLORECTAL CANCER
SYNDROMES:
• Familial syndromes such as familial adenomatous polyposis.
• (FAP)—an autosomal dominant disorder caused by mutations in
the adenomatous polyposis Coli (APC) gene on chromosome 5—
may lead to an increased risk of colon cancer.
• In FAP, Cancers commonly develop in adolescence and young
adulthood, and the incidence of colorectal Neoplasms is nearly
100% by age 50 years.

12. CONT….
• Hereditary nonpolyposis colon cancer.
• (HNPCC or lynch syndrome) is associated with a lower but
significant risk of cancer of the Colon and rectum.
• Mutations in tumor suppressor genes such as MCC, DCC, BRCA1,
and p53
• Also confer higher risks for colorectal neoplasms.

13. SCREENING
• A. Adults with signs or symptoms consistent with colorectal neoplasm should
undergo testing To exclude the presence of a mass.
• B. All average-risk adults aged 50 years or older should undergo one or more of
the following: annual Fecal occult blood test (FOBT) or fecal immunochemical
test (FIT), flexible sigmoidoscopy every 5 years, double-contrast barium enema
(DCBE) every 5 years, CT colonography every 5 years, or Colonoscopy every 10
years. All positive tests should be followed up with a colonoscopy.
• C. High-risk patients, including those with a personal or family history of
colorectal cancer or Adenomatous polyps, a history of FAP or HNPCC, or a
history of inflammatory bowel disease, Should be screened earlier and more
frequently.

14. PATHOLOGY
• A. The large majority of colorectal neoplasms are
adenocarcinomas, and most are well or moderately differentiated.
Poorly differentiated neoplasms are associated with poor
prognosis.
• B. Squamous cell carcinomas can arise in the anus. Such
neoplasms differ from adenocarcinomas in terms of biology and
therapy.

15. DIAGNOSIS
• Colonoscopy is the preferred diagnostic test for colorectal cancer
• Barium enema and fl exible sigmoidoscopy.
• Biopsy of suspicious lesions is required to establish a diagnosis.
• Tumor markers such as carcinoembryonic antigen (cea) or
carbohydrate antigen (ca).
• Radiologic studies are used to evaluate the extent of local disease
and to screen for metastatic disease.

19. STAGE 0 COLORECTAL CANCER
• Known as “cancer in situ,” meaning the
cancer is located in the mucosa (moist
tissue lining the colon or rectum)
• Removal of the polyp (polypectomy) is
the usual treatment

20. STAGE I COLORECTAL CANCER
• The cancer has grown through the
mucosa and invaded the muscularis
(muscular coat)
• Treatment is surgery to remove the
tumor and some surrounding lymph
nodes

21. STAGE II COLORECTAL CANCER
• The cancer has grown
beyond the muscularis of
the colon or rectum but
has not spread to the
lymph nodes
• Stage ii colon cancer is
treated with surgery and,
in some cases,
chemotherapy after
surgery
• Stage ii rectal cancer is
treated with surgery,
radiation therapy, and
chemotherapy

22. STAGE III COLORECTAL CANCER
• The cancer has spread to
the regional lymph nodes
(lymph nodes near the
colon and rectum)
• Stage iii colon cancer is
treated with surgery and
chemotherapy
• Stage iii rectal cancer is
treated with surgery,
radiation therapy, and
chemotherapy

23. STAGE IV COLORECTAL CANCER
• The cancer has spread
outside of the colon or
rectum to other areas of the
body
• Stage IV cancer is treated
with chemotherapy. Surgery
to remove the colon or rectal
tumor may or may not be
done
• Additional surgery to
remove metastases may also
be done in carefully selected
patients

24. Dukes staging system
A Mucosa 80%
B Into or through M. propria 50%
C1 Into M. propria, + LN ! 40%
C2 Through M. propria, + LN! 12%
D distant metastatic spread <5%

25. Goals of treatment
Treatment is defined by stage and type of cancer present
Goals of treatment for
early disease
• Remove cancer cells
• Kill cancer cells
• Keep the cancer cells
from returning
Goals of treatment for
advanced disease
• Slow or stop the growth of
cancer cells
• Manage quality of life
concerns

26. REFERENCES
• DAVIDSON’S
• KUMAR
• WEBSITE